Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study
Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in child...
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Published in | Frontiers in pharmacology Vol. 15; p. 1340255 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Switzerland
Frontiers Media S.A
13.03.2024
|
Subjects | |
Online Access | Get full text |
ISSN | 1663-9812 1663-9812 |
DOI | 10.3389/fphar.2024.1340255 |
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Abstract | Introduction:
We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma.
Methods:
Participants (6–14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort—a prospective, multicenter, observational study (NCT04480242)—were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey–Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System–Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables.
Results:
Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (
p
= 0.002) and HRQoL over time (
p
= 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (
p
= 0.012), but they showed better HRQoL in future assessments (
p
= 0.012). The frequency of reliever use was associated with symptom control (
p
< 0.001), exacerbation occurrence (
p
< 0.001), and HRQoL (
p
= 0.042); and boys were more likely to present better symptom control and HRQoL than girls.
Conclusion:
Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. |
---|---|
AbstractList | We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma.
Participants (6-14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables.
Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (
= 0.002) and HRQoL over time (
= 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (
= 0.012), but they showed better HRQoL in future assessments (
= 0.012). The frequency of reliever use was associated with symptom control (
< 0.001), exacerbation occurrence (
< 0.001), and HRQoL (
= 0.042); and boys were more likely to present better symptom control and HRQoL than girls.
Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma.Methods: Participants (6–14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort—a prospective, multicenter, observational study (NCT04480242)—were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey–Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System–Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables.Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls.Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6-14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population.Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6-14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort-a prospective, multicenter, observational study (NCT04480242)-were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey-Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System-Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6–14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort—a prospective, multicenter, observational study (NCT04480242)—were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey–Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System–Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control (p = 0.002) and HRQoL over time (p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously (p = 0.012), but they showed better HRQoL in future assessments (p = 0.012). The frequency of reliever use was associated with symptom control (p < 0.001), exacerbation occurrence (p < 0.001), and HRQoL (p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance treatment and inhalation technique present with symptom control, exacerbations, and health-related quality of life (HRQoL) in children and adolescents with asthma. Methods: Participants (6–14 years old) from the ARCA (Asthma Research in Children and Adolescents) cohort—a prospective, multicenter, observational study (NCT04480242)—were followed for a period from 6 months to 5 years via computer-assisted telephone interviews and a smartphone application. The Medication Intake Survey–Asthma (MIS-A) was administered to assess the implementation stage of adherence, and the Inhalation Technique Questionnaire (InTeQ) was used to assess the five key steps when using an inhaler. Symptom control was measured with the Asthma Control Questionnaire (ACQ), and HRQL was measured with the EQ-5D and the Patient-Reported Outcomes Measurement Information System–Pediatric Asthma Impact Scale (PROMIS-PAIS). Multilevel longitudinal mixed models were constructed separately with symptom control, exacerbation occurrence, EQ-5D, and PROMIS-PAIS as the dependent variables. Results: Of the 360 participants enrolled, 303 (1,203 interviews) were included in the symptom control and exacerbation analyses, 265 (732) in the EQ-5D, and 215 (617) in the PROMIS-PAIS. Around 60% of participants were male subjects, and most of them underwent maintenance treatment with inhaled corticosteroids plus long-acting β-agonists in a fixed dose (73.3%). Within-person variability was 83.6% for asthma control, 98.6% for exacerbations, 36.4% for EQ-5D, and 49.1% for PROMIS-PAIS. At the within-person level, patients with higher adherence had better symptom control ( p = 0.002) and HRQoL over time ( p = 0.016). Patients with a better inhalation technique reported worse HRQoL simultaneously ( p = 0.012), but they showed better HRQoL in future assessments ( p = 0.012). The frequency of reliever use was associated with symptom control ( p < 0.001), exacerbation occurrence ( p < 0.001), and HRQoL ( p = 0.042); and boys were more likely to present better symptom control and HRQoL than girls. Conclusion: Our results confirm longitudinal associations at the within-person level of the two indicators of quality use of inhalers: for adherence to maintenance treatment with symptom control and HRQoL, and for the inhalation technique with HRQoL. Although treatment adherence was shown to be excellent, a third of the participants reported a suboptimal inhalation technique, highlighting the need for actions for improving asthma management of the pediatric population. |
Author | Caballero-Rabasco, María Araceli Valdesoiro-Navarrete, Laura Dima, Alexandra L. Garin, Olatz Lizano-Barrantes, Catalina Ferrer, Montse Guerra, María Teresa Pont, Angels Praena-Crespo, Manuel Mayoral, Karina Bercedo-Sanz, Alberto |
AuthorAffiliation | 13 Centro de Salud Los Castros, Servicio Cántabro de Salud, Santander , Cantabria , Spain 4 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP , Madrid , Spain 11 Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA) , Universitat Autònoma de Barcelona , Sabadell , Spain 6 Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu , Esplugues de Llobregat , Spain 7 Pediatric Allergy and Pulmonology Unit , Pediatric Service , Hospital del Mar , Barcelona , Spain 5 National Heart and Lung Institute , Imperial College London , London , United Kingdom 10 Pediatric Allergy and Pulmonology Unit , Pediatric Service , Hospital Universitari Parc Taulí , Sabadell , Spain 8 Centro de Salud La Candelaria , Servicio Andaluz de Salud , Seville , Spain 9 Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP) , Madrid , Spain 1 Health Services Research Group , Hospital del Mar Resea |
AuthorAffiliation_xml | – name: 2 Department of Medicine and Life Sciences , Universitat Pompeu Fabra , Barcelona , Spain – name: 3 Department of Pharmaceutical Care and Clinical Pharmacy , Faculty of Pharmacy , Universidad de Costa Rica , San Jose , Costa Rica – name: 5 National Heart and Lung Institute , Imperial College London , London , United Kingdom – name: 7 Pediatric Allergy and Pulmonology Unit , Pediatric Service , Hospital del Mar , Barcelona , Spain – name: 12 Centro de Salud Jerez Sur, Servicio Andaluz de Salud , Cadiz , Spain – name: 11 Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA) , Universitat Autònoma de Barcelona , Sabadell , Spain – name: 13 Centro de Salud Los Castros, Servicio Cántabro de Salud, Santander , Cantabria , Spain – name: 4 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP , Madrid , Spain – name: 10 Pediatric Allergy and Pulmonology Unit , Pediatric Service , Hospital Universitari Parc Taulí , Sabadell , Spain – name: 8 Centro de Salud La Candelaria , Servicio Andaluz de Salud , Seville , Spain – name: 6 Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu , Esplugues de Llobregat , Spain – name: 9 Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP) , Madrid , Spain – name: 1 Health Services Research Group , Hospital del Mar Research Institute , Barcelona , Spain |
Author_xml | – sequence: 1 givenname: Catalina surname: Lizano-Barrantes fullname: Lizano-Barrantes, Catalina – sequence: 2 givenname: Olatz surname: Garin fullname: Garin, Olatz – sequence: 3 givenname: Karina surname: Mayoral fullname: Mayoral, Karina – sequence: 4 givenname: Alexandra L. surname: Dima fullname: Dima, Alexandra L. – sequence: 5 givenname: Angels surname: Pont fullname: Pont, Angels – sequence: 6 givenname: María Araceli surname: Caballero-Rabasco fullname: Caballero-Rabasco, María Araceli – sequence: 7 givenname: Manuel surname: Praena-Crespo fullname: Praena-Crespo, Manuel – sequence: 8 givenname: Laura surname: Valdesoiro-Navarrete fullname: Valdesoiro-Navarrete, Laura – sequence: 9 givenname: María Teresa surname: Guerra fullname: Guerra, María Teresa – sequence: 10 givenname: Alberto surname: Bercedo-Sanz fullname: Bercedo-Sanz, Alberto – sequence: 11 givenname: Montse surname: Ferrer fullname: Ferrer, Montse |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38549668$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3389_fphar_2024_1340255 crossref_primary_10_18093_0869_0189_2024_34_4_506_514 crossref_primary_10_3389_fmicb_2024_1492783 |
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ContentType | Journal Article |
Copyright | Copyright © 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer. Copyright © 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer. 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer |
Copyright_xml | – notice: Copyright © 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer. – notice: Copyright © 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer. 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer |
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Keywords | asthma exacerbations asthma outcomes inhalation technique asthma symptom control adherence health-related quality of life pediatric asthma |
Language | English |
License | Copyright © 2024 Lizano-Barrantes, Garin, Mayoral, Dima, Pont, Caballero-Rabasco, Praena-Crespo, Valdesoiro-Navarrete, Guerra, Bercedo-Sanz and Ferrer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Paolo Montuschi, Catholic University of the Sacred Heart, Italy Jaime Correia de Sousa, University of Minho, Portugal Reviewed by: Alvaro Teijeiro, Pediatric Hospital of Cordoba, Argentina Edited by: Maria Teresa Herdeiro, University of Aveiro, Portugal |
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PublicationTitle | Frontiers in pharmacology |
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We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based... We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based maintenance... Introduction: We aimed to evaluate the longitudinal relationships, both at between- and within-person levels, that adherence to inhaled corticosteroid-based... |
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SubjectTerms | adherence asthma outcomes asthma symptom control health-related quality of life inhalation technique pediatric asthma Pharmacology |
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Title | Impact of treatment adherence and inhalation technique on asthma outcomes of pediatric patients: a longitudinal study |
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